Tooth Extraction (Including Wisdom Teeth)

 
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Tooth extractions, or the removal of one or more teeth, are usually used as a last resort in dentistry, as keeping the natural tooth in the mouth is ideal. There are many reasons why single or multiple extractions may be performed, including pervasive tooth decay, the impaction of wisdom teeth, or the need to create space for orthodontic devices.

The most significant short-term benefit associated with tooth extraction is the elimination of pain. If a tooth is severely decayed or an infection is present, removing the affected tooth almost immediately alleviates discomfort. However, it should be noted that further procedures are necessary to replace the extracted tooth. Leaving a gap is not a viable option as the other teeth tend to twist out of alignment to fill the space.

Why might I need to have a tooth extraction?

Tooth extractions are incredibly common procedures. It should be reiterated that an extraction is used as a procedure of last resort, when nothing more can be done to save the tooth.

Here is a brief overview of some of the main reasons for tooth extraction:

Deep decay – This is easily the most common reason for tooth extraction, accounting for around two-thirds of all extraction procedures performed. When decay affects the surface of the tooth as well as the pulp, root canal procedures cannot be performed. Root canal therapy is only viable where the general structure of the tooth is in stable condition.

Extra teeth –There are a variety of explanations associated with extra teeth, but most commonly they are baby teeth that do not shed. Extra teeth take up space on the arch, causing nearby teeth to twist out of place. A tooth extraction is necessary in this case to provide enough space for the teeth to properly realign.

Periodontal disease – Often teeth have to be extracted because the gums and underlying bone are so severely eroded that they can no longer hold the tooth in place securely. The cause of bone and gum recession is almost always advanced periodontal disease (gum disease). Poor bone density means that the chance of restoring the natural tooth is minimal.

Prior to braces – Traditional orthodontic braces require enough space to for the teeth to move into ideal alignment. If space cannot be created naturally, a tooth may be extracted as an alternative.

Fractured teeth – Fortunately, dentists are able to save injured teeth in most circumstances with the aid of root canal therapy. However, there are some instances where the tooth has become fractured in a way that makes repair impossible. Your oral health professional will remove the tooth and use a prosthetic replacement in most cases.

How is the extraction procedure performed?

Generally, tooth extraction can be simple in nature or involve more complex surgical processes. Simple extractions are performed on fully emerged teeth after applying local anesthetic to the treatment site. Instruments are used to elevate the tooth and then sever the periodontal ligament. The tooth is then carefully removed with dental forceps.

Surgical extractions are performed on teeth that are either invisible or inaccessible, like un-erupted wisdom teeth. An incision is usually made in the gum tissue and a drill is used to precisely remove some of the adjacent bone tissue. Sometimes, the tooth has to be split into several pieces to completely remove it.

Wisdom Teeth

Reasons to remove wisdom teeth

While not all wisdom teeth require removal, wisdom teeth extractions are most often performed because of an active problem such as pain, swelling, decay or infection, or as a preventative measure to avoid serious problems in the future. If impaction of one or more wisdom teeth is present, and left untreated, a number of potentially harmful outcomes can occur, including:

  • Damage to nearby teeth: Second molars (the teeth directly in front of the wisdom teeth) can be adversely affected by impacted wisdom teeth, resulting in tooth decay (cavities), periodontal disease (gum disease) and possible bone loss.
  • Disease: Although uncommon, cysts and tumors can occur in the areas surrounding impacted wisdom teeth.
  • Infection: Bacteria and food can become trapped under the gum tissue, resulting in an infection. The infection can cause considerable pain and danger.
  • Tooth Crowding: It has been theorized that impacted wisdom teeth can put pressure on other teeth and cause them to become misaligned (crowded or twisted). This theory isn’t universally accepted by all dental professionals, and it has never been validated by any scientific studies.

Wisdom teeth examination

As with any dental procedure, your dentist will want to initially conduct a thorough examination of the wisdom and surrounding teeth. Panoramic or digital X-rays will be taken in order for your dentist to evaluate the position of the wisdom teeth and determine if a current problem exists, or the likelihood of any potential future problems.  The X-rays can also expose additional risk factors, such as deterioration or decay of nearby teeth. Early evaluation and treatment (typically in the mid-teen years) is recommended in order to identify potential problems and to improve the results for patients requiring wisdom teeth extractions. Only after a thorough examination can your dentist provide you with the best options for your particular case.

What does the removal of wisdom teeth involve?

Wisdom teeth removal is a common procedure, generally performed under local anesthesia, intravenous (IV) sedation, or general anesthesia by a specially trained dentist in an office surgery suite. The surgery does not require an overnight stay, and you will be released with post-operative instructions and medication (if necessary), to help manage any swelling or discomfort.

If you have any questions or concerns about tooth extraction, please contact your oral health care provider.

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